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Zhu Z, Jiang L, Ding X. Advancing Breast Cancer Heterogeneity Analysis: Insights from Genomics, Transcriptomics and Proteomics at Bulk and Single-Cell Levels. Cancers (Basel) 2023; 15:4164. [PMID: 37627192 PMCID: PMC10452610 DOI: 10.3390/cancers15164164] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/23/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Breast cancer continues to pose a significant healthcare challenge worldwide for its inherent molecular heterogeneity. This review offers an in-depth assessment of the molecular profiling undertaken to understand this heterogeneity, focusing on multi-omics strategies applied both in traditional bulk and single-cell levels. Genomic investigations have profoundly informed our comprehension of breast cancer, enabling its categorization into six intrinsic molecular subtypes. Beyond genomics, transcriptomics has rendered deeper insights into the gene expression landscape of breast cancer cells. It has also facilitated the formulation of more precise predictive and prognostic models, thereby enriching the field of personalized medicine in breast cancer. The comparison between traditional and single-cell transcriptomics has identified unique gene expression patterns and facilitated the understanding of cell-to-cell variability. Proteomics provides further insights into breast cancer subtypes by illuminating intricate protein expression patterns and their post-translational modifications. The adoption of single-cell proteomics has been instrumental in this regard, revealing the complex dynamics of protein regulation and interaction. Despite these advancements, this review underscores the need for a holistic integration of multiple 'omics' strategies to fully decipher breast cancer heterogeneity. Such integration not only ensures a comprehensive understanding of breast cancer's molecular complexities, but also promotes the development of personalized treatment strategies.
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Affiliation(s)
- Zijian Zhu
- State Key Laboratory of Oncogenes and Related Genes, Institute for Personalized Medicine, Shanghai Jiao Tong University, Shanghai 200030, China;
| | - Lai Jiang
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, School of Medicine and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200025, China;
| | - Xianting Ding
- State Key Laboratory of Oncogenes and Related Genes, Institute for Personalized Medicine, Shanghai Jiao Tong University, Shanghai 200030, China;
- Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, School of Medicine and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200025, China;
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Memirie ST, Habtemariam MK, Asefa M, Deressa BT, Abayneh G, Tsegaye B, Abraha MW, Ababi G, Jemal A, Rebbeck TR, Verguet S. Estimates of Cancer Incidence in Ethiopia in 2015 Using Population-Based Registry Data. J Glob Oncol 2019; 4:1-11. [PMID: 30241262 PMCID: PMC6223441 DOI: 10.1200/jgo.17.00175] [Citation(s) in RCA: 145] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose Noncommunicable diseases, prominently cancer, have become the second leading cause of death in the adult population of Ethiopia. A population-based cancer registry has been used in Addis Ababa (the capital city) since 2011. Availability of up-to-date estimates on cancer incidence is important in guiding the national cancer control program in Ethiopia. Methods We obtained primary data on 8,539 patients from the Addis Ababa population-based cancer registry and supplemented by data on 1,648 cancer cases collected from six Ethiopian regions. We estimated the number of the commonest forms of cancer diagnosed among males and females in Ethiopia and computed crude and age-standardized incidence rates. Results For 2015 in Ethiopia, we estimated that 21,563 (95% CI, 17,416 to 25,660) and 42,722 (95% CI, 37,412 to 48,040) incident cancer cases were diagnosed in males and females, respectively. The most common adult cancers were: cancers of the breast and cervix, colorectal cancer, non-Hodgkin lymphoma, leukemia, and cancers of the prostate, thyroid, lung, stomach, and liver. Leukemia was the leading cancer diagnosis in the pediatric age group (age 0 to 14 years). Breast cancer was by far the commonest cancer, constituting 33% of the cancers in women and 23% of all cancers identified from the Addis Ababa cancer registry. It was also the commonest cancer in four of the six Ethiopian regions included in the analysis. Colorectal cancer and non-Hodgkin lymphoma were the commonest malignancies in men. Conclusion Cancer, and more prominently breast cancer, poses a substantial public health threat in Ethiopia. The fight against cancer calls for expansion of population-based registry sites to improve quantifying the cancer burden in Ethiopia and requires both increased investment and application of existing cancer control knowledge across all segments of the Ethiopian population.
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Affiliation(s)
- Solomon Tessema Memirie
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Mahlet Kifle Habtemariam
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Mathewos Asefa
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Biniyam Tefera Deressa
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Getamesay Abayneh
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Biniam Tsegaye
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Mihiret Woldetinsae Abraha
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Girma Ababi
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Timothy R Rebbeck
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Stéphane Verguet
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
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Yip CH. Challenges in the early detection of breast cancer in resource-poor settings. BREAST CANCER MANAGEMENT 2016. [DOI: 10.2217/bmt-2016-0026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Breast cancer is increasing in low- and middle-income countries (LMICs) compared with high-income countries, where presentation with later stages coupled with suboptimal treatment leads to a high mortality rate. An important strategy is to detect cancers at an early stage where cure is possible. Screening mammography requires resources that are not available in LMICs. Clinical breast examination and breast self-examination have not been shown to reduce mortality from breast cancer. Despite efforts to promote early detection, barriers to early detection in LMICs persist, and these barriers are not only due to poverty and illiteracy, but also due to psychosocial and cultural issues present in LMICs. Clearly, there are many challenges to early detection in LMICs that have to be addressed.
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Affiliation(s)
- Cheng-Har Yip
- Department of Surgery, Sime Darby Healthcare, Kuala Lumpur, Malaysia
- Department of Surgery, University Tunku Abdul Rahman, Kuala Lumpur, Malaysia
- Department of Surgery, University Malaya, Kuala Lumpur 50603, Malaysia
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A systematic review and quality appraisal of international guidelines for early breast cancer systemic therapy: Are recommendations sensitive to different global resources? Breast 2015; 24:309-17. [PMID: 25900382 DOI: 10.1016/j.breast.2014.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 10/19/2014] [Accepted: 12/08/2014] [Indexed: 12/25/2022] Open
Abstract
The breast cancer incidence in low and middle income countries (LMCs) is increasing globally, and patient outcomes are generally worse in these nations compared to high income countries (HICs). This is partly due to resource constraints associated with implementing recommended breast cancer therapies. Clinical practice guideline (CPG) adherence can improve breast cancer outcomes, however, many CPGs are created in HICs, and include costly recommendations that may not be feasible in LMCs. In addition, the quality of CPGs can be variable. The aim of this study was to perform a systematic review of CPGs on early breast cancer systemic therapy with potential international impact, to evaluate their content, quality, and resource sensitivity. A MEDLINE and gray literature search was completed for English language CPGs published between 2005 and 2010, and then updated to July 2014. Extracted guidelines were evaluated using the AGREE 2 instrument. Guidelines were specifically analyzed for resource sensitivity. Most of the extracted CPGs had similar recommendations with regards to systemic therapy. However, only one, the Breast Health Global Initiative, made recommendations with consideration of different global resources. Overall, the CPGs were of variable quality, and most scored poorly in the quality domain evaluating implementation barriers such as resources. Published CPGs for early breast cancer are created in HICs, have similar recommendations, and are generally resource-insensitive. Given the visibility and influence of these CPGs on LMCs, efforts to create higher quality, resource-sensitive guidelines with less redundancy are needed.
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Zelle SG, Baltussen R, Otten JDM, Heijnsdijk EAM, van Schoor G, Broeders MJM. Predicting the stage shift as a result of breast cancer screening in low- and middle-income countries: a proof of concept. J Med Screen 2014; 22:8-19. [PMID: 25416699 DOI: 10.1177/0969141314559956] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To provide proof of concept for a simple model to estimate the stage shift as a result of breast cancer screening in low- and middle-income countries (LMICs). Stage shift is an essential early detection indicator and an important proxy for the performance and possible further impact of screening programmes. Our model could help LIMCs to choose appropriate control strategies. METHODS We assessed our model concept in three steps. First, we calculated the proportional performance rates (i.e. index number Z) based on 16 screening rounds of the Nijmegen Screening Program (384,884 screened women). Second, we used linear regression to assess the association between Z and the amount of stage shift observed in the programme. Third, we hypothesized how Z could be used to estimate the stage shift as a result of breast cancer screening in LMICs. RESULTS Stage shifts can be estimated by the proportional performance rates (Zs) using linear regression. Zs calculated for each screening round are highly associated with the observed stage shifts in the Nijmegen Screening Program (Pearson's R: 0.798, R square: 0.637). CONCLUSIONS Our model can predict the stage shifts in the Nijmegen Screening Program, and could be applied to settings with different characteristics, although it should not be straightforwardly used to estimate the impact on mortality. Further research should investigate the extrapolation of our model to other settings. As stage shift is an essential screening performance indicator, our model could provide important information on the performance of breast cancer screening programmes that LMICs consider implementing.
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Affiliation(s)
- Sten G Zelle
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Rob Baltussen
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Johannes D M Otten
- Department for Health Evidence, Radboud university medical center, Nijmegen, The Netherlands
| | | | - Guido van Schoor
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Mireille J M Broeders
- Department for Health Evidence, Radboud university medical center, Nijmegen, The Netherlands Dutch reference centre for screening, Nijmegen, The Netherlands
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Abstract
Breast cancer is one of the leading cancers world-wide. While the incidence in developing countries is lower than in developed countries, the mortality is much higher. Of the estimated 1 600 000 new cases of breast cancer globally in 2012, 794 000 were in the more developed world compared to 883 000 in the less developed world; however, there were 198 000 deaths in the more developed world compared to 324 000 in the less developed world (data from Globocan 2012, IARC). Survival from breast cancer depends on two main factors--early detection and optimal treatment. In developing countries, women present with late stages of disease. The barriers to early detection are physical, such as geographical isolation, financial as well as psychosocial, including lack of education, belief in traditional medicine and lack of autonomous decision-making in the male-dominated societies that prevail in the developing world. There are virtually no population-based breast cancer screening programs in developing countries. However, before any screening program can be implemented, there must be facilities to treat the cancers that are detected. Inadequate access to optimal treatment of breast cancer remains a problem. Lack of specialist manpower, facilities and anticancer drugs contribute to the suboptimal care that a woman with breast cancer in a low-income country receives. International groups such as the Breast Health Global Initiative were set up to develop economically feasible, clinical practice guidelines for breast cancer management to improve breast health outcomes in countries with limited resources.
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Affiliation(s)
- C H Yip
- Department of Surgery, University Malaya , Kuala Lumpur , Malaysia
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8
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Dey S. Preventing breast cancer in LMICs via screening and/or early detection: The real and the surreal. World J Clin Oncol 2014; 5:509-519. [PMID: 25114864 PMCID: PMC4127620 DOI: 10.5306/wjco.v5.i3.509] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/27/2014] [Accepted: 06/11/2014] [Indexed: 02/06/2023] Open
Abstract
To review the present status of breast cancer (BC) screening/early detection in low- and middle-income countries (LMICs) and identify the way forward, an open focused search for articles was undertaken in PubMed, Google Scholar and Google, and using a snowball technique, further articles were obtained from the reference list of initial search results. In addition, a query was put up on ResearchGate to obtain more references and find out the general opinion of experts on the topic. Experts were also personally contacted for their opinion. Breast cancer (BC) is the most common cancer in women in the world. The rise in incidence is highest in LMICs where the incidence has often been much lower than high-income countries. In spite of more women dying of cancer than pregnancy or childbirth related causes in LMICs, most of the focus and resources are devoted to maternal health. Also, the majority of women in LMICs present at late stages to a hospital to initiate treatment. A number of trials have been conducted in various LMICs regarding the use of clinical breast examination and mammography in various combinations to understand the best ways of implementing a population level screening/early detection of BC; nevertheless, more research in this area is badly needed for different LMIC specific contexts. Notably, very few LMICs have national level programs for BC prevention via screening/early detection and even stage reduction is not on the public health agenda. This is in addition to other barriers such as lack of awareness among women regarding BC and the presence of stigma, inappropriate attitudes and lack of following proper screening behavior, such as conducting breast self-examinations. The above is mixed with the apathy and lack of awareness of policy makers regarding the fact that BC prevention is much more cost-effective and humane than BC treatment. Implementation of population level programs for screening/early detection of BC, along with use of ways to improve awareness of women regarding BC, can prove critical in stemming the increasing burden of BC in LMICs. Use of newer modalities such as ultrasonography which is more suited to LMIC populations and use of mHealth for awareness creation and increasing screening compliance are much needed extra additions to the overall agenda of LMICs in preventing BC.
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Youlden DR, Cramb SM, Yip CH, Baade PD. Incidence and mortality of female breast cancer in the Asia-Pacific region. Cancer Biol Med 2014; 11:101-15. [PMID: 25009752 PMCID: PMC4069805 DOI: 10.7497/j.issn.2095-3941.2014.02.005] [Citation(s) in RCA: 186] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 02/11/2014] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To provide an overview of the incidence and mortality of female breast cancer for countries in the Asia-Pacific region. METHODS Statistical information about breast cancer was obtained from publicly available cancer registry and mortality databases (such as GLOBOCAN), and supplemented with data requested from individual cancer registries. Rates were directly age-standardised to the Segi World Standard population and trends were analysed using joinpoint models. RESULTS Breast cancer was the most common type of cancer among females in the region, accounting for 18% of all cases in 2012, and was the fourth most common cause of cancer-related deaths (9%). Although incidence rates remain much higher in New Zealand and Australia, rapid rises in recent years were observed in several Asian countries. Large increases in breast cancer mortality rates also occurred in many areas, particularly Malaysia and Thailand, in contrast to stabilising trends in Hong Kong and Singapore, while decreases have been recorded in Australia and New Zealand. Mortality trends tended to be more favourable for women aged under 50 compared to those who were 50 years or older. CONCLUSION It is anticipated that incidence rates of breast cancer in developing countries throughout the Asia-Pacific region will continue to increase. Early detection and access to optimal treatment are the keys to reducing breast cancer-related mortality, but cultural and economic obstacles persist. Consequently, the challenge is to customise breast cancer control initiatives to the particular needs of each country to ensure the best possible outcomes.
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Affiliation(s)
- Danny R Youlden
- 1 Cancer Council Queensland, Brisbane 4006, Australia ; 2 School of Mathematical Sciences, Queensland University of Technology, Brisbane 4000, Australia ; 3 Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia ; 4 Griffith Health Institute, Griffith University, Gold Coast 4222, Australia ; 5 School of Public Health and Social Work, Queensland University of Technology, Brisbane 4000, Australia
| | - Susanna M Cramb
- 1 Cancer Council Queensland, Brisbane 4006, Australia ; 2 School of Mathematical Sciences, Queensland University of Technology, Brisbane 4000, Australia ; 3 Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia ; 4 Griffith Health Institute, Griffith University, Gold Coast 4222, Australia ; 5 School of Public Health and Social Work, Queensland University of Technology, Brisbane 4000, Australia
| | - Cheng Har Yip
- 1 Cancer Council Queensland, Brisbane 4006, Australia ; 2 School of Mathematical Sciences, Queensland University of Technology, Brisbane 4000, Australia ; 3 Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia ; 4 Griffith Health Institute, Griffith University, Gold Coast 4222, Australia ; 5 School of Public Health and Social Work, Queensland University of Technology, Brisbane 4000, Australia
| | - Peter D Baade
- 1 Cancer Council Queensland, Brisbane 4006, Australia ; 2 School of Mathematical Sciences, Queensland University of Technology, Brisbane 4000, Australia ; 3 Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia ; 4 Griffith Health Institute, Griffith University, Gold Coast 4222, Australia ; 5 School of Public Health and Social Work, Queensland University of Technology, Brisbane 4000, Australia
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Kantelhardt EJ, Zerche P, Mathewos A, Trocchi P, Addissie A, Aynalem A, Wondemagegnehu T, Ersumo T, Reeler A, Yonas B, Tinsae M, Gemechu T, Jemal A, Thomssen C, Stang A, Bogale S. Breast cancer survival in Ethiopia: a cohort study of 1,070 women. Int J Cancer 2014; 135:702-9. [PMID: 24375396 DOI: 10.1002/ijc.28691] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 12/11/2013] [Indexed: 11/07/2022]
Abstract
There is little information on breast cancer (BC) survival in Ethiopia and other parts of sub-Saharan Africa. Our study estimated cumulative probabilities of distant metastasis-free survival (MFS) in patients at Addis Ababa (AA) University Radiotherapy Center, the only public oncologic institution in Ethiopia. We analyzed 1,070 females with BC stage 1-3 seen in 2005-2010. Patients underwent regular follow-up; estrogen receptor-positive and -unknown patients received free endocrine treatment (an independent project funded by AstraZeneca Ltd. and facilitated by the Axios Foundation). The primary endpoint was distant metastasis. Sensitivity analysis (worst-case scenario) assumed that patients with incomplete follow-up had events 3 months after the last appointment. The median age was 43.0 (20-88) years. The median tumor size was 4.96 cm [standard deviation (SD) 2.81 cm; n = 709 information available]. Stages 1, 2 and 3 represented 4, 25 and 71%, respectively (n = 644). Ductal carcinoma predominated (79.2%, n = 1,070) as well as grade 2 tumors (57%, n = 509). Median follow-up was 23.1 (0-65.6) months, during which 285 women developed metastases. MFS after 2 years was 74% (69-79%), declining to 59% (53-64%) in the worst-case scenario. Patients with early stage (1-2) showed better MFS than patients with stage 3 (85 and 66%, respectively). The 5-year MFS was 72% for stages 1 and 2 and 33% for stage 3. We present a first overview on MFS in a large cohort of female BC patients (1,070 patients) from sub-Saharan Africa. Young age and advanced stage were associated with poor outcome.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/therapy
- Cohort Studies
- Combined Modality Therapy
- Ethiopia/epidemiology
- Female
- Follow-Up Studies
- Humans
- Middle Aged
- Neoplasm Grading
- Neoplasm Metastasis
- Neoplasm Staging
- Prognosis
- Survival Rate
- Young Adult
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Affiliation(s)
- E J Kantelhardt
- Department of Gynaecology, Martin Luther University, Halle an der Saale, Germany; Institute of Clinical Epidemiology, Martin Luther University, Halle an der Saale, Germany
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Patani N, Martin LA, Dowsett M. Biomarkers for the clinical management of breast cancer: international perspective. Int J Cancer 2013; 133:1-13. [PMID: 23280579 DOI: 10.1002/ijc.27997] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 12/07/2012] [Indexed: 12/14/2022]
Abstract
The higher incidence of breast cancer in developed countries has been tempered by reductions in mortality, largely attributable to mammographic screening programmes and advances in adjuvant therapy. Optimal systemic management requires consideration of clinical, pathological and biological parameters. Oestrogen receptor alpha (ERα), progesterone receptor (PgR) and human epidermal growth factor receptor 2 (HER2) are established biomarkers evaluated at diagnosis, which identify cardinal subtypes of breast cancer. Their prognostic and predictive utility effectively guides systemic treatment with endocrine, anti-HER2 and chemotherapy. Hence, accurate and reliable determination remains of paramount importance. However, the goals of personalized medicine and targeted therapies demand further information regarding residual risk and potential benefit of additional treatments in specific circumstances. The need for biomarkers which are fit for purpose, and the demands placed upon them, is therefore expected to increase. Technological advances, in particular high-throughput global gene expression profiling, have generated multi-gene signatures providing further prognostic and predictive information. The rational integration of routinely evaluated clinico-pathological parameters with key indicators of biological activity, such as proliferation markers, also provides a ready opportunity to improve the information available to guide systemic therapy decisions. The additional value of such information and its proper place in patient management is currently under evaluation in prospective clinical trials. Expanding the utility of biomarkers to lower resource settings requires an emphasis on cost effectiveness, quality assurance and possible international variations in tumor biology; the potential for improved clinical outcomes should be justified against logistical and economic considerations.
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Affiliation(s)
- Neill Patani
- The Breakthrough Breast Cancer Research Center, The Institute of Cancer Research, London, United Kingdom
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Yip CH, Taib NA. Challenges in the management of breast cancer in low- and middle-income countries. Future Oncol 2013; 8:1575-83. [PMID: 23231519 DOI: 10.2217/fon.12.141] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The incidence of breast cancer is rising in low- and middle-income countries (LMICs) due to 'westernization' of risk factors for developing breast cancer. However, survival remains low because of barriers in early detection and optimal access to treatment, which are the two main determinants of breast cancer outcome. A multidisciplinary approach to treatment gives the best results. An accurate diagnosis is dependent on a reliable pathology service, which will provide an adequate pathology report with prognostic and predictor information to allow optimal oncological treatment. Stratification of clinical practice guidelines based on resource level will ensure that women will have access to treatment even in a low-resource setting. Advocacy and civil society play a role in galvanizing the political will required to meet the challenge of providing opportunities for breast cancer control in LMICs. Collaboration between high-income countries and LMICs could be a strategy in facing these challenges.
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Affiliation(s)
- Cheng-Har Yip
- Department of Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
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14
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De Ver Dye T, Bogale S, Hobden C, Tilahun Y, Hechter V, Deressa T, Bize M, Reeler A. A mixed-method assessment of beliefs and practice around breast cancer in Ethiopia: implications for public health programming and cancer control. Glob Public Health 2011; 6:719-31. [PMID: 20865612 DOI: 10.1080/17441692.2010.510479] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A large proportion of breast cancer patients in Ethiopia present for biomedical care too late, or not at all, resulting in high mortality. This study was conducted to better learn of beliefs and practices among patients accessing breast cancer services in a large referral centre in Ethiopia. Using a mixed-method design, we interviewed 69 breast cancer patients presenting for care at Tikur Anbessa Hospital in Addis Ababa, Ethiopia, about their beliefs, experiences and perspectives on breast cancer. Awareness of breast cancer is low in Ethiopia and even among those who are aware of the disease, a sense of hopelessness and fatalism is common. Early signs/symptoms are frequently ignored and patients often first present to traditional healers. Breast cancer is perceived as being caused typically from humoral anomalies or difficulties resulting from breast feeding, and study participants indicate that stigmatisation and social isolation complicate discussion and action around breast cancer. Consistent with other studies, this study shows that traditional beliefs and practices are common around breast cancer and that numerous barriers exist to identification and treatment in Ethiopia. Integrating health beliefs and practice into public health action in innovative ways may reduce stigma, increase awareness and promote survivability among breast cancer patients.
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Affiliation(s)
- Timothy De Ver Dye
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, 505 Irving Avenue, Room 4004, Syracuse, NY 13210, USA.
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Affiliation(s)
- Anthony Howell
- Breakthrough Breast Cancer Research Unit, Paterson Institute for Cancer Research, School of Cancer, Enabling Science and Technology, University of Manchester, Manchester, UK.
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Wadler BM, Judge CM, Prout M, Allen JD, Geller AC. Improving Breast Cancer Control via the Use of Community Health Workers in South Africa: A Critical Review. JOURNAL OF ONCOLOGY 2010; 2011:150423. [PMID: 20936151 PMCID: PMC2948888 DOI: 10.1155/2011/150423] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 08/23/2010] [Indexed: 12/21/2022]
Abstract
Breast cancer is a growing concern in low- and middle-income countries (LMCs). We explore community health worker (CHW) programs and describe their potential use in LMCs. We use South Africa as an example of how CHWs could improve access to breast health care because of its middle-income status, existing cancer centers, and history of CHW programs. CHWs could assume three main roles along the cancer control continuum: health education, screening, and patient navigation. By raising awareness about breast cancer through education, women are more likely to undergo screening. Many more women can be screened resulting in earlier-stage disease if CHWs are trained to perform clinical breast exams. As patient navigators, CHWs can guide women through the screening and treatment process. It is suggested that these roles be combined within existing CHW programs to maximize resources and improve breast cancer outcomes in LMCs.
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Affiliation(s)
- Brianna M. Wadler
- Division of Public Health Practice, Harvard School of Public Health, 677 Huntington Avenue, Landmark 3rd Floor East, Boston, MA 02115, USA
| | - Christine M. Judge
- Division of Public Health Practice, Harvard School of Public Health, 677 Huntington Avenue, Landmark 3rd Floor East, Boston, MA 02115, USA
| | - Marianne Prout
- Department of Epidemiology, Boston University School of Public Health, 715 Albany St, Talbot Building, Boston, MA 02118, USA
| | - Jennifer D. Allen
- Center for Community-Based Research, Cantor Center for Nursing Research and Patient Care Services, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115, USA
| | - Alan C. Geller
- Division of Public Health Practice, Harvard School of Public Health, 677 Huntington Avenue, Landmark 3rd Floor East, Boston, MA 02115, USA
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Love RR. Adjuvant hormonal therapy in premenopausal women with operable breast cancer: not-so-peripheral perspectives. ONCOLOGY (WILLISTON PARK, N.Y.) 2010; 24:322-7. [PMID: 20464842 PMCID: PMC3073037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Reviews of issues around adjuvant hormonal therapies for breast cancer in premenopausal women often focus on recent and current large clinical trials, and fail to address other subjects that are very germane to evidence-based and investigatory clinical practice. These topics include: (1) the descriptive epidemiology of breast cancer globally, (2) critical issues in tumor hormone receptor testing, (3) compelling data demonstrating that hormone receptor-positive breast cancer is a chronic disease, (4) data supportive of combined hormonal therapy with tamoxifen as the standard of care, and the limited justifications for awaiting the SOFT and TEXT trial results, (5) pharmacogenetic hypotheses with tamoxifen, (6) ethical issues in ovarian suppression vs ablative treatment, and (7) emerging data about the importance of primary tumor removal surgery itself and "surgical stress" in solid tumor management.
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Affiliation(s)
- Richard R Love
- The Ohio State University Comprehensive Cancer Center Columbus, Ohio, USA.
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Anderson BO, Yip CH, Smith RA, Shyyan R, Sener SF, Eniu A, Carlson RW, Azavedo E, Harford J. Guideline implementation for breast healthcare in low-income and middle-income countries: overview of the Breast Health Global Initiative Global Summit 2007. Cancer 2009; 113:2221-43. [PMID: 18816619 DOI: 10.1002/cncr.23844] [Citation(s) in RCA: 326] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Breast cancer outcomes in low- and middle-income countries (LMCs) correlate with the degree to which 1) cancers are detected at early stages, 2) newly detected cancers can be diagnosed correctly, and 3) appropriately selected multimodality treatment can be provided properly in a timely fashion. The Breast Health Global Initiative (BHGI) invited international experts to review and revise previously developed BHGI resource-stratified guideline tables for early detection, diagnosis, treatment, and healthcare systems. Focus groups addressed specific issues in breast pathology, radiation therapy, and management of locally advanced disease. Process metrics were developed based on the priorities established in the guideline stratification. The groups indicated that cancer prevention through health behavior modification could influence breast cancer incidence in LMCs. Diagnosing breast cancer at earlier stages will reduce breast cancer mortality. Programs to promote breast self-awareness and clinical breast examination and resource-adapted mammographic screening are important early detection steps. Breast imaging, initially with ultrasound and, at higher resource levels with diagnostic mammography, improves preoperative diagnostic assessment and permits image-guided needle sampling. Multimodality therapy includes surgery, radiation, and systemic therapies. Government intervention is needed to address drug-delivery problems relating to high cost and poor access. Guideline dissemination and implementation research plays a crucial role in improving care. Adaptation of technology is needed in LMCs, especially for breast imaging, pathology, radiation therapy, and systemic treatment. Curricula for education and training in LMCs should be developed, applied, and studied in LMC-based learning laboratories to aid information transfer of evidence-based BHGI guidelines.
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Affiliation(s)
- Benjamin O Anderson
- Department of Surgery, University of Washington, Seattle, Washington 98195, USA.
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